Publications (7)12.92 Total impact

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To our knowledge, no trial has so far been performed of 5-fluorouracil (5-FU) in the treatment of discoid lupus erythematosus. This open label study was carried out in 12 patients (5 males and 7 females, aged 20 to 47 years) to assess the short-and long-term efficacy and tolerability of a daily application of an ointment containing 5% 5-FU. The study was started in October 1993 when the disease was at a high degree of activity following summer sunlight exposure. After a 4-to 24-week treatment period, full remission was achieved in all patients. Healing resulted in cosmetically acceptable dyschromic and/or atrophic changes. During the summers 1994 and 1995, exacerbation of preexisting lesions and appearance of new lesions were observed in eight and two patients, respectively. However, remission of these lesions was obtained with a short course of therapy. The overall tolerability of the treatment was good or excellent in all patients. On the basis of the results of this preliminary study, topical 5-FU seems to be a promising therapeutic agent which might be introduced in the routine management of cutaneous lupus erythematosus.

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We report a case of necrobiosis lipoidica diabeticorum in a 36-year-old man suffering from uncompensated diabetes mellitus. The dermatosis was characterized by dark-red infiltrated patches with protruding peripheral borders located on the lower extremities, the dorsal aspects of the feet and hands, and the trunk. Histologically the lesions showed a palisaded granuloma in the middermis. The patient was treated with oral cyclosporin A (CsA) which resulted in a marked improvement in the clinical picture. The rationale for this therapeutic approach is briefly discussed.

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The aetiopathogenesis of pityriasis lichenoides (PL) is still far from clearly understood. However, the involvement of delayed-type immune dysfunctions has recently been hypothesized. On the basis of this premise, and in view of the recognized immunomodulating effects of synthetic derivatives of vitamin A, an open trial was carried out of the efficacy and tolerability of oral etretinate in four men, aged 21 to 49 years, with PL. With a daily dosage of 1 mg/kg, full resolution was achieved in 6-18 weeks. The overall tolerability was good, with mild to moderate mucocutaneous side-effects. The relapse-free period had currently reached 8-12 months. Oral etretinate seems to be a promising therapeutic tool in the management of PL, for which to date no definitive treatment exists.

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A total of 30 patients with severe recalcitrant alopecia areata were randomly assigned to one of three groups. One group was treated with topical immunotherapy (TI) with squaric acid dibutylester at weekly intervals, for a maximum of 32 weeks, the second group was treated with lymphoblastoid interferon (IFN) alpha given by the intramuscular route for a 3-month period, and the third group received a combination of both treatments. After discontinuation of therapy the patients were followed-up at 4-week intervals for a 6-month period. At the end of this period, clinical responses were assessed according to the following four-point scale: 3 = full and stable recovery with a 6-month relapse-free period; 2 = full recovery with relapse occurring within 6 months; 1 = partial recovery; 0 = no response or disease progression. Combination (TI + IFN) therapy patients had significantly (P = 0.02) higher cure rates. In this group, scores of 3 and 2 were given to three and two patients, respectively. By contrast, in both monotherapy groups no score 3 was assigned, and only two patients were assessed as score 2. This study provides some support for the hypothesis that the association of TI and systemic IFNs are more effective than either treatment alone. The possibility of a synergistic action is discussed.

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Lichen myxoedematosus (papular mucinosis) is characterized by papular lesions (and sometimes by internal involvement) caused by a dermal infiltrate of acid mucopolysaccharides which induce extensive thickening and hardening of the skin. The aetiopathogenesis of the disease is unknown. The therapy is generally by immunosuppression. We report the case of a 63-year-old man with lichen myxoedematosus successfully treated with cyclosporin A.